Provider Demographics
NPI:1316235294
Name:WILLIAMS-CUSANO, AISHA NICOLE (LPC)
Entity type:Individual
Prefix:
First Name:AISHA
Middle Name:NICOLE
Last Name:WILLIAMS-CUSANO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:AISHA
Other - Middle Name:NICOLE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 184
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:VA
Mailing Address - Zip Code:22963-0184
Mailing Address - Country:US
Mailing Address - Phone:434-589-8276
Mailing Address - Fax:434-589-2690
Practice Address - Street 1:13623 JAMES MADISON HWY
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:VA
Practice Address - Zip Code:22963-4300
Practice Address - Country:US
Practice Address - Phone:434-589-8276
Practice Address - Fax:434-589-2690
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005054101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional